COPD, Chronic bronchitis, Emphysema

1. COPD
Abdul Waris Khan
Soepel: 2
Det: Internal medicine

2. SOEPEL
• Subjective: A 55 years old male smoker presented to
ER with shortness of breath and productive cough.
• H/O presenting illness: The symptoms have been
there for 3 years and now worsened. He is a chain
smoker more than pack a day for the past 20 years. He
is known to be hypertensive. No other past medical or
family history.

3. • Objective: physical examination
• Pulse: 77
• RR: 20
• BP: 125/90
• Evaluation: DD: COPD, Asthma
• Plan: Spirometry, sputum culture
• Elaboration: Bronchodilators, corticosteroids, antibiotics

4. Learning goals: COPD

5. Definition
• Chronic obstructive pulmonary disease (COPD) is a preventable and
treatable disease state characterized by airflow limitation that is not fully
reversible.
• The airflow limitation is usually progressive and is associated with an
abnormal inflammatory response of the lungs to noxious particles or gases,
primarily caused by cigarette smoking.

6. • Chronic bronchitis is defined clinically as chronic productive cough for 3
months for most of the days in 2 successive years.
• Emphysema is defined as the presence of permanent enlargement of the
airspaces distal to the terminal bronchioles, accompanied by destruction of
their walls and without obvious fibrosis.

9. Tobacco smoke is the most important risk factor for COPD worldwide.

10. Pathophysiology
Tobacco smoking is the main risk factor for COPD.
This causes an inflammatory response in the lungs, which is exaggerated in
some smokers, and leads to the characteristic pathological lesions of COPD.
In addition to inflammation, an imbalance of proteinases and antiproteinases
in the lungs occur.

11. •The major antiproteinases involved in the pathogenesis of COPD include:
Alpha-1-antitrypsin
Secretory leukoproteinase inhibitor
Tissue inhibitors of MMPs.

14. Bronchitis

15. Emphysema

16. What abnormalities arise?
Mucous hyper secretion
Ciliary dysfunction
Airflow limitation
Hyperinflation
Gas exchange abnormalities

17. Symptoms.
 Cough
 Sputum
 Dyspnea

19. Investigations
CBC, ESR, CRP
Sputum culture
ABGs
Chest X ray
ECG

21. Flow-Volume Loops

22. Obstructive vs. Restrictive
• Obstructive Disorders
– Characterized by a limitation of
expiratory airflow so that airways
cannot empty as rapidly compared to
normal (such as through narrowed
airways from bronchospasm,
inflammation, etc.)
Examples:
– Asthma
– Emphysema/Bronchitis
– Cystic Fibrosis
• Restrictive Disorders
– Characterized by reduced lung
volumes/decreased lung compliance
Examples:
– Interstitial Fibrosis
– Scoliosis
– Obesity
– Lung Resection
– Neuromuscular diseases
– Cystic Fibrosis

23. • Obstructive Disorders
– FVC normal or↓
– FEV1 ↓
– FEF25-75% ↓
– FEV1/FVC ↓
– TLC normal or ↑
• Restrictive Disorders
– FVC ↓
– FEV1 ↓
– FEF 25-75% normal to ↓
– FEV1/FVC normal to ↑
– TLC ↓

29. References
• Kumar and Clark's clinical medicine 7th edition
• Davidson principals and practice of medicine 21st edition